The Society for Healthcare Epidemiology of America (SHEA) announced today that “I just know” will replace systematic reviews as the top level of evidence available in medical research. For years scientists and doctors have dismissed anecdotes from the likes of anti-vaxxers and pseudoscience pushers, but it appears they are finally ready to listen.

“After much research and deliberation, we feel we cannot ignore what a parent or conspiracy theorist feels “in their gut”. There are just too many anecdotes and too many people buying untested alternative health products to ignore this any longer,” explained SHEA spokesman Dr. Harold Rami.

Homeopaths, Naturopaths, Chiropractors and anti-vaxxers the world over are celebrating this as a huge victory.

“Even though my son was showing signs of autism before he got vaccinated, I know in my gut and in my heart that it was still the vaccines that caused it,” said mother and anti-vaccine advocate Cheryl Jones.

“This is a big win for us,” said Naturopath and homeopathy dispenser, Paul Theroult. “I have seen it many times. I sell my patients a homeopathic remedy – for say the common cold – and then bam, they are cured within one to two weeks. There is no science backing up my claim that the homepathic pill cured their cold, but in my gut I just know it did.”

The Dutch team investigating the MH17 Malaysian Airline crash in eastern Ukraine report it has problems collecting debris from the crash site in eastern Ukraine. But aren’t these problems largely of their own making? And isn’t this just one glaring example of the Catch-22 situation presented by problems of recognition in Ukraine?

On the one hand the investigation team has problems organising recovery of material – but on the other hand they refuse to negotiate with the authorities controlling the crash zone! Isn’t the solution obvious? - Talk to the local authorities. Don’t try to pretend they don’t exist and attempt to do everything through intermediaries like the OCSE.

The issue is just too important to allow such distraction by childish political games.

This impasse has gone on long enough. Four months since the crash and there has been no recovery of any of the crashed plane parts. This could have been done months ago. People are getting impatient – they want answers and the Dutch investigators are now criticised for dragging their feet. The situation has became more urgent because of the impending winter and the possibilities of destruction of evidence by shelling of the remains.

I can’t help thinking that even this military action, violating UN resolutions on the tragedy, could have been stopped if the Dutch investigators had manned up and applied more pressure on the Kiev government. After all, it is not the rebels who are shelling this area.

Problems of recognition

I understand the wish not to imply recognition of the rebels. But the Malaysian government negotiated with the local authorities right at the beginning and quickly obtained the recovered black boxes and began the task of recovering the passenger bodies. No recognition was implied by the contact – simply the willingness to discuss the practicalities with the people in the area. Why cannot the Dutch investigation team do the same?

The Dutch investigators claim it is because the government in Kiev does not want them to. But that did not stop the Malaysians. Nor should that be a real consideration considering that elements of the Kiev regime are possible suspects in the shooting down of the plane.

Ukraine’s attitude towards Malaysia did cool because of those direct negotiations. But the Kiev regime itself is caught in its own Catch-22 with its unwillingness to imply any recognition of the rebel regimes in the Donbass.

Right from the beginning, the day before the coup in Kiev (see Agreement on the Settlement of Crisis in Ukraine), agreements on Ukraine have referred to the need for constitutional reform in the country, and the need to involve all parts of the country in negotiating a new constitution. Neither the junta resulting from the coup or the subsequent elected president and government have shown any willingness to honour that aspect of agreements. They have negotiated with themselves and the oligarchs – but never with the real authorities in power in eastern Ukraine – or the people who support them.

Even the Trilateral Contact group on Ukraine which produced the recent cease-fire agreements did not have proper representation from the Kiev regime because they refused to negotiate with the representatives from Donetsk and Luhansk. Instead the Kiev government worked through the Second President of Ukraine, L.D. Kuchma.

Negotiation does not imply recognition

Again, there is the wish not to imply recognition. Interestingly Kiev been on the receiving end of that dilemma as the government of the Russian Federation did not recognise any presidential authority in a regime that had come to power via an armed coup after evicting a democratically elected president. That was eventually resolved when new presidential elections brought Poroshenko to power – and in the interim other forms of contact were used. I think this shows that non-recognition does not mean that contact and negotiation is impossible. Nor does negotiation imply recognition.

Since the February coup there have been presidential and parliamentary elections in Ukraine and a referendum plus parliamentary and government elections in the Donbass. One can easily find fault with all these elections and the referendum but the important thing is that they have given a degree of legitimacy to the governments in Kiev and the Donbass. This means their officials have increased authority in any negotiations – which surely makes possible better progress in stopping hostilities, carrying out constitutional reform and settling the degree of autonomy granted to the Donbass region.

Instead, the Kiev government is using the increased legitimacy in the Donbass as further reason not to negotiate. The Prime Minister Arseniy Yatsenyuk wants to abandon the Minsk talks altogether and go back to the Geneva negotiations format which did not include representatives of the rebel forces.

“Sitting [down] with them for bilateral negotiations is useless,” Yatsenyuk said. “One of the most efficient and real formats is the Geneva format, which included the participation of the US, the EU, Ukraine and our geographically northern neighbor.”

Yet, surely, negotiation between both sides in this civil war is the only way to reach the peaceful settlement which most Ukrainian’s want. Does this imply the Kiev government refuses to try to reach a peaceful settlement?

How can Yatsenyuk claim such negotiations are useless when he has consistently refused to even try them?

Whatever – his approach does not seem politically mature. Negotiations should never be seen as a sign of weakness, but rather a sign of strength which comes with a willingness to deal with realities on the ground.

RE: CWF Working Paper Article

Dear Daniel,
I have now had a chance to consider your comments to my draft article. In some respects, I am flattered that you have devoted so much time to an unpublished working paper, and I thank you for giving me some of your opinions. I absolutely want to make sure that I have cited to sources accurately and have not mischaracterized any particular study I reviewed. To that end, I have now engaged independent review of my article from several highly-qualified scientists/researchers with the specific request that they review my article for scientific accuracy. After I have received their comments, I will revise my draft accordingly.

Unfortunately (or fortunately for me), I did not find in your review any specific places where I actually mischaracterized any cited study. Instead, your primary points of contention seem to be twofold: (1) you object to my use of Fluoride Action Network’s (“FAN”) website as a cited source; and (2) you object to my failure to include contrary studies that reaffirm the (English-speaking countries’) public health agencies’/dental lobby positions on the safety and benefits of compulsory water fluoridation.

First, with respect to my reliance on FAN. Of the 209 footnote references in my article, I believe only 17 of them are cites to FAN. Of those 17 cites, I am citing to the FAN website primarily as an easy way to get to the primary source material (e.g., studies or newspaper articles from around the world). For example, in footnotes 85-87, I could have listed the primary source studies, but I have found that many of these studies are hard to get on the internet for those who do not have paid subscriptions to the various science databases. I myself had to order a number of the primary sources from my University intra-library loan system and felt that it would be better to simply provide a link so that the reader could see the names of the studies and determine for himself/herself how to get to those primary sources. Nevertheless, your point is well-taken that I should not give the appearance of relying upon an advocacy group (including yours), and I will review those 17 cites to see if I should instead cite to primary sources.

Second, with respect to your complaint or desire that I cite to contrary (i.e., pro-fluoridation) studies in addition to (or in lieu of) the published studies that I cite that tend to weigh against fluoridation, as I have already indicated to you on two occasions: I am not interested in a battle of the studies debate, and I urge you to conduct such a battle with a more appropriate sparring partner, such as FAN-NZ. Specifically: you complain about FAN not being a legitimate source of credible scientific information, but your organization is also a political advocacy (pro-fluoridation) group, and, from your critique, you are just as guilty of “cherry picking” your sources and your studies as you suggest I am. Moreover, and in stark contrast to you, the section of my article where the studies are discussed is specifically entitled: “Scientific Evidence Against Compulsory Water Fluoridation.” It is not meant to be an exhaustive examination of all studies on fluoridation and is specifically and accurately identified for what it is. I am well aware of many of the pro-fluoridation studies — as well as the criticisms of many of those studies (in terms of who funded them, flaws in methodology, conflicts of interest, etc.) by those opposed to fluoridation. I do not believe either side has definitively proved their case with respect to safety/benefits or lack thereof. However, what I do believe is that the burden of proving safety and effectiveness lies with the pro-fluoridation side, as it is your side that is insisting on imposing this “public health measure” on everyone else, even in the face of substantial objection and despite existing studies suggesting serious risks of harm. It also appears to me that the pro-fluoridation side is playing “whack a mole” with the studies weighing against CWF – often trying to hammer down/marginalize the opposition each time a negative study pops up, rather than trying to consider the evidence objectively. I note throughout your critique that you often refer to studies that weigh against fluoridation as “flawed” or “debatable” or as somehow lacking in proper control mechanisms – while studies that support fluoridation are “quality studies.” (p.8). You also minimize any existing evidence weighing against fluoridation by qualifying it: “there is no quality research” (p. 4) “there is no robust evidence” (p. 4), “there is no strong evidence” (p. 6). However, to me, if even one strong study exists, then the entire compulsory practice must be reevaluated.

Please also note that any and all of your cites to the ADA lobby, or to the CDC (which, though its oral health division, works hand in hand with the ADA promoting fluoridation and thus has a serious conflict of interest/credibility problem) are unpersuasive to me – as they should be to anyone conducting even a minimum level of research into the history of and politics behind fluoridation (some of which is chronicled in my article, including the story of the EPA’s NTEU battle). Incidentally, as someone who did not have a pony in this race before doing the actual research (i.e., I am not a long-time anti-fluoridation advocate), it does not take long to discover how politically motivated many “public health agencies” and “professional dental associations” are — or how willing they are to obscure, minimize, or bury contrary evidence or to marginalize the anti-fluoridation messengers, regardless of the evidence or the credentials of those messengers (e.g., Waldbott, Taylor, Marcus, Mullenix, Bassin, Hirzy).

With respect to the NRC Report, I agree with you that it did not specifically address compulsory water fluoridation. However, I believe that its review of fluoride toxicology is highly relevant to exposures from fluoridated water (and its exposure data itself suggests that some people drinking fluoridated water can, indeed, receive doses that can cause adverse health effects, including severe dental fluorosis and bone fractures). In addition, in a number of health risk areas, the NRC panel concluded that there was not enough data, and/or that more research needed to be conducted, before definitive statements could be made with respect to other potential adverse health effects due to excess exposure to fluoride. This is hardly a ringing endorsement of the safety of fluoride or fluoridation. Nor is the NRC Report irrelevant to the fluoridation debate.

I see no point in going through your critique page by page to point out various flaws in it, as mostly you seem to be trying to persuade me with contrary evidence rather than identifying any mischaracterizations of the studies I did cite. I will, however, point out that your opening accusation on p. 2 that my “paper starts off by saying there is mounting scientific evidence against fluoridation” and that I used an opinion piece by John Colquhoun as my “evidence” to support this statement is outrageously incorrect, and it almost prompted me not to respond to you at all, as I do not appreciate my words being twisted or my cites misused to inflate your argument. This statement about “mounting scientific evidence” at the start of my paper (near fn. 2) actually references an entire section of my article – (“See discussion infra Sec. II-B”) — and not an opinion piece by Colquhoun, which is only referenced – appropriately – at footnote 65 (referring to “formerly avid fluoride proponents” who have changed their minds). I have no desire to engage with insincere zealots, so I hope that you simply made a mistake there.

As I said to you privately, I am more than willing to revise my article where I have misstated any of the cited scientific evidence. However, I disagree with you that a discussion on the legal and ethical aspects of CWF would be “confusing” or “pointless” at this point and I would genuinely be interested in knowing why you feel so strongly that imposing this practice on everyone is ethically justifiable. Data published by the WHO suggests that the decline in dental caries is similar in both fluoridated and unfluoridated countries, and I have heard of no massive outbreak of a worldwide dental carie epidemic that has been attributed to a lack of fluoridated water (rather than to poverty, poor nutrition, or a lack of access to proper dental care). Thus, I am very curious as to why there appears to be such an aggressive campaign on the pro-fluoridation side to impose this practice on the world – and why anyone believes that personal liberties and rights to bodily integrity should be sacrificed for a public health practice addressing a non-contagious disease. I would also be interested in understanding where you personally believe compulsory public health practices should begin and end (e.g., do you believe governments should mandate compulsory flu shots? What about the HPV vaccine that the Governor of Texas tried to mandate for girls? Where should the personal right to bodily integrity begin and end, in your opinion? And how comfortable are you with public health officials mandating what is good for you? Do you contend that they haven’t been wrong on a public health issue before?).

As for me, I remain convinced that CWF is legally and ethically unjustifiable. My article sets forth my reasons, so I won’t repeat those arguments here. These reasons would remain even if compulsory water fluoridation were proven to be entirely safe, which it most definitely has not, despite the presumed “majority” view in the English speaking countries. You will also find many of my reasons articulated by dissenting justices in fluoridation cases over the last 60+ years, when presumably even less “science” was available to support their nevertheless valid legal/ethical objections to CWF. I include some of these cases and dissenting opinions in my article.

Daniel, I thank you for your (heretofore) civilized exchange with me and I do welcome your thoughts if you have any on the legal and ethical justifications of CWF. After this exchange, however, I am only interested in a private discussion with you, which is something you may not be interested in as it may not advance your organization’s agenda. However, your facebook posting has generated some contact to me by a few rude (and seemingly unbalanced) pro-fluoridation folks, and I have no interest in entertaining their rants (which certainly do nothing but convince me that the pro-fluoridation side has something to hide). In any event, I do thank you for reaching out and for your interest in my article. I hope to ensure that my final draft will address any legitimate criticisms/issues.
Sincerely,
Rita

Recently an unpublished paper by Rita F. Barnett, an associated professor of Legal Research and Writing at Chapman University, was heavily promoted by Paul Connett’s Fluoride Action Network and associated social media groups. Although basically a legal paper it did have a comprehensive section on the scientific aspects of fluoridation.

Rita F. Barnett

She argued that the science indicated that community water fluoridation was neither effective or safe and was criticised for that. One of her critics, Daniel Ryan from the Making Sense of Fluoride group, participated in an exchange with her about the science.

As this has only been available in downloadable pdf format I am posting this exchange over the next few days as part of the ongoing fluoridation debate.

This post today is the section from Rita Barnett’s paper in which she argues that the science does not support community water fluoridation.

Scientific evidence against compulsory water fluoridation

Fluoridation proponents have historically characterized those opposing or questioning fluoridation as “irrational, fanatical, unscientific, or fraudulent,” regardless of the legitimate scientific credentials of those opposing fluoridation.64 However, the mounting scientific evidence against fluoridation has begun to persuade an increasing number of scientific researchers and dental and medical professionals, and even some formerly avid fluoride proponents.65

While a comprehensive review of all existing and emerging toxicological, clinical and epidemiological studies weighing against fluoridation or urging further research is beyond the purview of this article, a brief discussion of some current areas of concern follows.

1: Dental Fluorosis

Dental fluorosis occurs when children absorb too much fluoride. This excess fluoride “causes the biochemical signal to go awry, thereby creating gaps in the crystalline enamel structure.”66 When the tooth finally erupts, is it unevenly colored, and may even be pitted and brown.67

Although early fluoride proponents claimed that mild dental fluorosis was the only potential, and relatively rare, negative side effect to systemic fluoride exposure, today about 30-40% of American teenagers show visible signs of dental fluorosis, with the rate as high as 70-80% in some fluoridated areas.68

Exposure to multiple sources of fluoride beyond fluoridated water supplies may partly explain the higher than expected rates of dental fluorosis, the first sign of fluoride toxicity. Indeed, it is nearly impossible today to avoid consuming fluoride even in non-fluoridated areas, since fluoride is now found in fluoridated toothpaste, the pesticide residue on fresh produce, processed food and beverages made with fluoridated water, and many pharmaceuticals.69 Yet, research from the Iowa Fluoride Study, the largest long-running investigation on the effects of fluoride, has indicated that the most important risk factor for dental fluorosis is exposure to fluoridated water.70 Perhaps for this reason, the American Dental Association now recommends that parents use non-fluoridated water for infant baby formula, while the Institute of Medicine recommends that babies only consume a miniscule 10 micrograms of fluoride daily, a near impossible feat when babies are fed infant formula reconstituted with fluoridated water – even where levels are within the “optimal” range of 0.7- 1 ppm.71

Despite the fact that dental fluorosis not only produces unattractive teeth but may also increase the risk of tooth loss, the EPA and other U.S. public health officials downgraded even moderate to severe dental fluorosis from an adverse health effect to a purely cosmetic one.72 This downgrade has been largely perceived as a bow to political pressure rather than a legitimate health risk assessment.73 In any event, “it is widely acknowledged that dental fluorosis is a manifestation of systemic toxicity,” leading to far more serious health risks than unattractive teeth alone.74

2: Skeletal Fluorosis and Bone Fractures

Fluoride, of course, is not equipped with a smart GPS, able to provide benefits to teeth while bypassing bone and other organs of the human body.75 Instead, approximately 93% of ingested fluoride is absorbed into the bloodstream, and while some of it is excreted, roughly 50% is deposited into bone, potentially leading to skeletal fluorosis.76 Skeletal fluorosis is characterized by painful and limited joint movement, spinal deformities, muscle wasting, and calcification of the ligaments.77 Numerous studies have already linked skeletal fluorosis to excess fluoride intake, and although health officials had formerly insisted that skeletal fluorosis would not develop unless a person ingested 20 milligrams of fluoride per day for over 10 years, current research now suggests that doses as low as 6 mg/day can cause early stages of the disease, and that skeletal fluorosis can develop even with fluoride levels as low at 0.7 to 1.5 ppm, the range used in many fluoridation schemes throughout the United States.78 Unfortunately, skeletal fluorosis may go undetected or misdiagnosed because some of the symptoms mimic symptoms of arthritis or other bone diseases, and because many doctors do not know how to diagnose it.79

In addition to skeletal fluorosis, epidemiological studies have now also linked high fluoride exposure to an increase in bone fractures, especially in vulnerable populations such as the elderly and diabetics.80 Related studies have shown that people once given fluoride to “cure” osteoporosis wound up having increased fracture rates.81

3: Pineal Gland and Endocrine Disruption Studies

Researchers have now discovered that an even greater amount of fluoride accumulates in the pineal gland than in teeth and bone.82 The pineal gland is responsible for the synthesis and secretion of the hormone melatonin, which regulates the body’s circadian rhythm cycle and puberty in females, and helps to protect the body from cell damage from free radicals.83 While it is not yet known if fluoride accumulation affects pineal gland function in humans, experiments have already found that fluoride reduced melatonin levels, interfered with sleep-wake cycles, and shortened the time to puberty in animals.84

In addition, studies have now shown that fluoride can contribute to hypothyroidism (an underactive thyroid), which is unsurprising, since fluoride was once used as a prescription drug to reduce thyroid gland function in patients with hyperthyroidism (an overactive thyroid).85 The fluoride dose capable of reducing thyroid function is low – just 2 to 5 mg per day over several months. This is well within the range of what individuals living in fluoridated communities are receiving on a regular basis.86

4: Cancer Studies

Numerous studies have now suggested a link between cancer and fluoride.87 However, perhaps even more disturbing than the evidence supporting the fluoride-cancer link is the evidence suggesting that political and other agendas have played a large part in the outright suppression of this evidence.88

First, in the early 1950’s, Dr. Alfred Taylor, a biochemist at the University of Texas, conducted a series of experiments in which cancer prone mice consuming water treated with sodium fluoride were found to have shorter lifespans than cancer-prone mice drinking non-fluoridated water.89 After discovering that his first round of tests had been contaminated because both groups of mice had eaten food containing fluoride, Dr. Taylor repeated the experiment, and found the same results – a shorter life span for the mice drinking the fluoridated water. However, because these damaging results appeared around the launch time of the early fluoridation schemes, and because public health officials had already come out in staunch support of fluoridation, Dr. Taylor’s work was misrepresented. Specifically, fluoridation proponents falsely claimed that Dr. Taylor had never conducted the second study revealing that the fluoride-cancer link was still present when the necessary controls were put in place.90

Then, in 1990, a study conducted by the U.S. government’s National Toxicology Program (“NTP”) found a positive relation for osteosarcoma (bone cancer) in male rats exposed to different amounts of fluoride in drinking water.91 When NTP downplayed the results in order to avoid a public outcry over compulsory fluoridation, a storm of controversy erupted, with a number of scientists outraged at the failure to report the cancer linked results accurately.92

Finally, in 2006, Elise Bassin and her colleagues at the Harvard School of Dental Medicine published a study in the peer-reviewed journal Cancer Causes and Control, which also showed a link between fluoridation and osteosarcoma in young men.93 Incredibly, Bassin’s own dissertation advisor at Harvard, Chester Douglass, wrote a commentary in the same journal warning readers to be “especially cautious” about Bassin’s results. This lead to yet another controversy, with Bassin’s defenders calling for an ethical investigation of Douglass, since, as it turned out, Douglass had some conflicts of interest and was the editor in chief of a newsletter for dentists funded by Colgate. 94

5: Lower IQ’s in Children

Researchers have also begun to focus on the damaging effects fluorides appear to have on the human brain. In the 1990’s, researcher Phyllis Mullenix studied the brain and behavioral effects of sodium fluoride on rats.95 Her study revealed that pre-natal exposure to fluoride correlated with life-long hyperactivity in young rats, while post-natal exposures often had the opposite, “couch potato” effect.96 Although Mullenix’s research was published in a well-respected peer reviewed journal, the fluoride proponents attacked her methodology and declared her results flawed.97 Since then, however, forty-six other studies have emerged showing a connection between excess exposure to fluoride and lowered IQ’s in children, with 39 of the 46 finding that elevated fluoride exposure is associated with decreased IQ, and 29 of the 31 animal studies showing that fluoride exposure impairs the learning and/or memory capacity of animals.98

In 2012, after conducting a meta-analysis of 27 of the fluoride-human IQ studies, conducted mostly in China, a team of scientists from Harvard’s School of Public Health and China’s Medical University in Shenyang concluded that the studies suggested an average IQ decrease of about seven points in children exposed to raised fluoride concentrations.99 In 2014, one of the chief authors of the initial 2012 meta-analysis, Harvard professor Philippe Grandjean, concluded in a follow-up article that “our very great concern is that children worldwide are being exposed to unrecognized toxic chemicals that are silently eroding intelligence,” and that fluoride’s effect on the young brain should now be a “high research priority.”100 Notably, a majority of the 27 studies analyzed were of water fluoride levels of less than 4 mg/L, which falls under the allowable concentrations of fluoride under current EPA regulations.101

6: Benefits from Systemic Fluoride Intake?

With so many current studies linking fluoride to serious health risks beyond dental fluorosis, the question remains whether fluoride’s public health benefits outweigh any and all of these risks. The Centers for Disease Control has deemed water fluoridation one of the “top ten health achievements of the 20th Century.”102 Proponents therefore insist that even if there are a number of recognized risks of fluoridation, there has been enough evidence to show that these risks are remote and are far outweighed by the benefits.103 Yet much of the available scientific data today suggests that any benefit from fluoride in terms of preventing tooth decay has been from topical application, rather than systemic ingestion.104 Moreover, even the benefits of topical fluoride treatments have been recently questioned, since most dental caries today are in the “pits and fissures” of the molars rather than on the flat surface of teeth, and various studies have now indicated that fluoride has no impact on the pits and fissures.105

Research conducted over the last twenty years has also shown that the estimated reduction in tooth decay due to compulsory water fluoridation has been grossly exaggerated. While at one time proponents boasted a 50-65% reduction in tooth decay, a great deal of current evidence suggests the real percentage is significantly lower, with some studies showing no measurable reduction at all. 106 Confounding claims of benefit even further, numerous studies have shown a substantially similar decline in the dental caries rate in countries that do not fluoridate, and in areas within the United States that remain unfluoridated.107

Nor have the asserted economic benefits of compulsory water fluoridation come to fruition. In fact, a number of economic evaluation studies have indicated that the costs of dental care may actually be higher in fluoridated communities than in non-fluoridated communities.108

Unfortunately, rather than considering the new data objectively, public health officials and dental lobbies spearheading fluoridation schemes often ignore, reject, or suppress the evidence that does not toe the pro-fluoride party line.109 Nevertheless, as evidence against fluoridation continues to 20 Compulsory Water Fluoridation [23 Sept 14 accumulate in a variety of health risk areas, two conclusions seem readily apparent. First, there remain significant unanswered questions about the risks and benefits of systemic fluoride, and further research before imposing or continuing fluoridation schemes seems not only scientifically prudent, but ethically necessary. Second, it is no longer acceptable for public health officials to simply dismiss the accruing negative data and to continue to insist that the levels of fluoride children and adults are receiving on a daily basis are without any serious health consequences. Fortunately, tentative moves by the EPA and other federal agencies suggest that at least some public health authorities are inching towards similar conclusions.

References

64 See e.g. Hileman, supra note 18, at 4. See also Graham, supra note 17, at 195 (noting a pro-fluoridation report characterizing fluoride opponents as follows: “The opposition stems from several sources, chiefly food faddists, cultists, chiropractors, misguided and misinformed persons who are ignorant of the scientific facts on the ingestion of water fluorides, and, strange as it may seem, even among a few uniformed physicians and dentists.”). See also Leila Barraza, Daniel G. Orenstein, Doug Campos- Outcalt, Denialism and Its Adverse Effect on Public Health, 53 JURIMETRICS J. 307, 307 (calling those who oppose fluoridation “denialists” who “misuse science to advocate positions that contradict the overwhelming weight of existing evidence”).

70 Fagin, supra note 26, at 79 (children exposed to fluoridated water were 50% more likely to have dental fluorosis than children living in non-fluoridated areas).

71 Peckham, supra note 13, at 165-66.

2 See Hileman, supra note 18 at 10.

73 Id.

74 Peckham, supra note 13, at 166.

75 Limeback, supra note 65 (“it is illogical to assume that tooth enamel is the only tissue affected by low daily doses of fluoride ingestion.”); Colquhoun, supra note 65 (“Common sense should tell us that if a poison circulating in a child’s body can damage the tooth-forming cells, then other harm also is likely.”).

93 E. B. Bassin et. al., Age Specific Fluoride Exposure in Drinking Water and Osteosarcoma, 17 CANCER CAUSES & CONTROL 421-28 (2006) (finding an association between fluoride exposure in drinking water during childhood and the incidence of osteosarcoma among males but not consistently among females). See also S Kharb et. al., Fluoride Levels and Osteosarcoma, 1 SOUTH ASIAN J. CANCER 76-77 (2012) (finding positive correlation between fluoride and osteosarcoma).

100 Philippe Grandjean & Philip Landrigan, Neurobehavioural Effects of Developmental Toxicity, 13 THE LANCET NEUROLOGY, 330-338 (2014) (“untested chemicals should not be presumed to be safe to brain development, and chemicals in existing use and all new chemicals must therefore be tested for developmental neurotoxicity.”). See also Diana Rocha-Amador, Decreased Intelligence in Children and Exposure to Fluoride and Arsenic in Drinking Water, Cad. Saude Publica, Rio de Janeiro, 23 Sup. S579-587 (2007).

101 See discussion infra Sec. III.

102 CDC FLUORIDATION, supra note 18.

103 Hileman, supra note 18, at 2.

104 See Czajka, supra note 13, at 127.

105 See e.g., Letter from Dr. Paul Connett to Scientific Committee on Health and Environmental Risks, the European Committee, at #7 (March 30, 2009), available at http://www.fluoridealert.org/wp-content/uploads/scher.march_.2009.pdf (“Since 1950, it has been found that fluorides do little to prevent pit and fissure tooth decay…This is significant because pit and fissure tooth decay represents up to 85% of the tooth decay experienced by children today.”).

106 Hileman, supra note 18, at 5.

107 Hileman, supra note 18, at 6-7. See also Michael Connett, Tooth Decay Trends in Fluoridated vs. Unfluoridated Countries (March 2012), FLUORIDEALERT.ORG, http://fluoridealert.org/studies/caries01/ (noting that decay rates in non-fluoridated countries have declined at the same rate as those in fluoridated countries).

108 Hileman, supra note 18, at 7. 109 See e.g., Voices of Opposition Have Been Suppressed Since Early Days of Fluoridation, CHEMICAL & ENGINEERING NEWS (August 1, 1988), available at

It’s funny how we all recognise confirmation bias in others but a loath to see it in ourselves.

Yet it is only human – and in fact the desire to fit new evidence into existing models in our mind does play an important role in attempts to understand the real world. At the same time, one must realise that our mental models do not correspond exactly to reality, no matter how good they are, or we think they are.

That is why it is important to develop the skills to recognise when our mental models really are out of step with new evidence, with reality.

Julia Galef trains people to do this. To learn to change their mind. She described the process in her talk at TAM 2014.

Over recent months I have been following, and learning more about, the issues of fluoridation and the Ukrainian civil war. One is a scientific issue (at least in most of the debate), the other political. Yet in the social media discussions both issues are dominated by motivated reasoning, cherry-picking, confirmation bias and outright prejudice. The same thing is going on in both issues and in many cases show denial, the favouring of belief over facts and evidence.

Donald Prothero points out that this is just human nature. We are not “rational machines,” and, if we are honest, we should all be able to recognises these faults in our own approaches, no matter how sceptical and scientific we think we are.

Prothero presented an interesting talk at the recent Amazing Meeting in Las Vegas, he deals mainly with creationism, climate change denial and anti-vaccination beliefs but the lessons have much wider applicability.

He has some great cartoons in his lecture. But I also liked how he drew lessons from his analysis about how supporters of science and scepticism should deal with discussions when science denial occurs. Simple antagonistic argument and debunking is usually not effective. We need to recognise the beliefs and values underlying the denial and respond to those.

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